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HealthPartners Maple (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthPartners Maple (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthPartners Maple (PPO) in 2025, please refer to our full plan details page.
HealthPartners Maple (PPO) is a PPO plan offered by HealthPartners, Inc. available for enrollment in 2025 to people living in Northeastern Wisconsin including Door County. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that HealthPartners Maple (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HealthPartners Maple (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For HealthPartners Maple (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $62.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6500.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $6500.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The HealthPartners Maple (PPO) plan has a $200 deductible for prescription drugs. After you meet your deductible, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, for a standard generic drug, you will pay a $9 copay at a standard pharmacy. For preferred brand drugs, you pay 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HealthPartners Maple (PPO) plan offers comprehensive coverage with a variety of benefits. Inpatient hospital stays have a $300 copay for the first five days, then no copay for the remainder of the stay. Outpatient services, emergency services, primary care, and hearing services are covered with copays ranging from $20 to $350, depending on the specific service. Preventive services are covered with no copay. The plan also provides coverage for vision and dental services with copays, as well as home health, skilled nursing, and ambulance services. Additional benefits include coverage for acupuncture, over-the-counter items, and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient hospital stays are covered, including acute and psychiatric care, with a copay of $300 for days 1-5 and no copay for days 6-90. Additional days for both acute and psychiatric care are covered with no copay, while non-Medicare covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered under the HealthPartners Maple (PPO) plan. Outpatient Hospital Services have a $350 copay, and Observation Services have a $300 copay, while Ambulatory Surgical Center (ASC) Services have a $325 copay. Outpatient Substance Abuse Services include individual and group sessions, with a copay between $25 and $25.
Partial Hospitalization See details
Partial Hospitalization is covered by the HealthPartners Maple (PPO) plan. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HealthPartners Maple (PPO) plan. Ground and Air Ambulance Services have a $300 copay and no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the HealthPartners Maple (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $40 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $300 copay; all have no coinsurance.
Primary Care See details
The HealthPartners Maple (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $40 copay, mental health specialty services with a $25 copay for individual and group sessions, other health care professional services with a copay between $0 and $40, psychiatric services with a $25 copay for individual and group sessions, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services. Podiatry services are not covered.
Preventive Services See details
The HealthPartners Maple (PPO) plan covers preventive services, including no copay for Medicare-covered preventive services, annual physical exams, and additional preventive services. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing Services include routine hearing exams with a $40 copay for one visit per year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $499 and $999 for two hearing aids per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a $40 copay, and coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, and upgrades. Routine eye exams are covered once per year.
Dental Services See details
Dental Services under the HealthPartners Maple (PPO) plan include a $40 copay for Medicare Dental Services, with a $500 maximum benefit per year for other dental services, including oral exams, dental x-rays, and other preventive services. Restorative Services and Periodontics are also covered, but Adjunctive General Services, Endodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HealthPartners Maple (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay of $35, Lab Services with a coinsurance of at most 10%, Diagnostic Radiological Services with a copay of at most $225, Therapeutic Radiological Services with a coinsurance of at most 20%, and Outpatient X-Ray Services with a copay of $35. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the HealthPartners Maple (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the HealthPartners Maple (PPO) plan, but the plan does not cover the listed sub-services. The plan does not specify any cost sharing for the covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HealthPartners Maple (PPO) plan, with no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HealthPartners Maple (PPO) plan covers acupuncture with a $40 copay, up to 20 treatments per year. Over-the-counter items are covered up to $50 every three months, and the plan also offers a meal benefit for a chronic illness. US Emergency Travel Logistics, Travel Counseling, and Treatment at the Scene are also covered, with a $300 copay for the latter.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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